With a history dating to the French Revolution, the Sisters of Bon Secours (French for good help) traveled from Paris to the US in 1824 with a mission to minister to the sick and dying. They established the world's first recorded formal home healthcare service. Today, the Sisters remain a driving force in how Bon Secours cares for patients and employees.

Meghan Melvin (Wellness Manager, Bon Secours Richmond), notes the wellness program there traces its roots back over 20 years. “In the beginning, Cindy Stutts (Administrative Director for Wellness, Occupational Health, and EAP) offered small wellness programs at our largest facility, St. Mary’s Hospital. Over the years, it expanded to other hospitals throughout the Richmond area and into Hampton Roads.”

Incentives Tied to Benefit Plan

Approximately 4 years ago, the health system identified a need to improve health in the entire population. Benefits and wellness incentives were linked to reward employees for healthy behaviors. A generous 3-tiered incentive structure allows them to earn up to $900 in Health Reimbursement Account credits:

The first requirement is participation in an annual personal health assessment (Richmond had an 85% participation rate in 2013); it shows an aggregate perspective of workforce health and scores employees’ readiness to change in a multitude of areas.

The second tier encourages employees to earn healthy habit incentives. This can be accomplished by logging steps (or syncing tracking devices like Fitbit®) in the employee portal and completing daily challenges such as meditating for 20 minutes. They also offer a tobacco cessation course (by phone and in-person coaching). Although Bon Secours Virginia implemented smoke-free campuses and nicotine-free hiring many years ago, they continue to support the needs of populations who were “grandfathered in” and struggle to quit.

The last incentive is for healthy weight; employees with a BMI of 27.5 or below earn it automatically. The reasoning comes from Dee Edington’s research, which shows that once a person’s BMI moves above 27.5 their risk for chronic conditions greatly increases. For employees with a higher BMI, Bon Secours offers several options such as coaching, logging exercise, or losing 10% of their weight on their own.

Meghan explains how data for these tiers is collected: “We use Dee Edington’s model for risk reduction. The portal provides the opportunity to track trends over time. Even though our workforce is aging, we’ve seen a downward shift in risks. We also use readiness-to-change questionnaires so we can see what the population thinks about their health and how they want to change.” Meghan emphasizes the value of a web portal in today’s high-tech environment. “It’s the world we live in. Based on their unique needs, people can link together and support each other. They can journal, enter personal data, research information, or reach out to a coach with a question.”

Accountable Care Organization (ACO) Reduces Costs

Bon Secours Virginia wanted to be a healthcare leader by positively affecting employee health while reducing the system’s annual healthcare expenditure for chronic conditions. They recognized that cost follows risk. This led management to create a values-based ACO targeted at improving care quality and delivery.

Meghan states their employee health issues reflect that of the American population. “Our employees struggle with obesity, heart disease, and diabetes. Because we are self-insured we had to do something to get ahead of our costs. We took a deep dive into the data and identified that 15% of our employees drive 78% of our costs, and 50%-70% of the costs are attributed to lifestyle habits within the employee’s control or ability to change. On the first year of our journey we tested the ACO concept with about 200 participants. We paired employees with chronic high-risk conditions with intensive telephone coaching to assist them in setting goals and learning healthy habits to help control these conditions. In the second year we took a similar approach with 200 more high-risk participants.”

Then, in the third round, Meghan’s team shifted their focus to everybody. “We realized that while we focused on the high risk, people in the low and moderate risk were beginning to creep up into higher-risk categories. That’s why we turned to the total population approach. We enrolled 2000 people and added advanced lab testing that identified those in a prediabetic state. Studies show this to be the optimal time to intervene. We then stratified participants according to risk group and provided intensive telephone coaching.”

Ultimately, they hope to see 70% of their population in the low-risk category. Before 2014 Bon Secours offered a financial incentive to enroll in the ACO; the incentive is now outcome-based — to earn the incentive, employees must meet the goals set with their coaches. Meghan says phone coaches now coordinate participants entering other wellness programs. “For instance, our fantastic weight management program includes group support, dietitian counseling, meal planning, and an intensive exercise program. Additional programs and challenges are offered throughout the year as well as ongoing educational webinars.”

Meghan comments that nurses were a difficult target audience to reach. “They’re committed to their patients and families and often put personal needs last. We implemented our stress management program over a year ago, and the nurses are participating as they never have before. Such mental health strategies are definitely improving our outcomes.”

Top-Down Management Commitment

Meghan confirms that support for the wellness program starts at the top and works its way down. “Bon Secours Virginia CEO, Peter Bernard, supported a stairwell renovation in the hospitals. We replaced the old, white interior with bright colors and motivational messaging. About the same time his office moved to the seventh floor, and from that day forward he vowed to never take the elevator again.”

“Almost a year ago we had 700 managers come together for a leadership conference. One entire day was dedicated to wellness, with Dee Edington as a guest speaker. We surveyed these managers and challenged them to commit to recognize their employees and encourage healthy behaviors. Out of that session, Bon Secours HealthSource CEO, Kevin Barr, asked me to set up a pedometer challenge and offered to buy pedometers for all participants.”

“Every 3 years our executives develop a strategic quality plan for the entire system; 3 years ago, wellness was added. The goal was to liberate our people through the mind, body, and spirit. There is no doubt wellness will continue to be a focus of the entire health system.”

Promoting Engagement

Meghan describes the importance of employee commitment in Bon Secours. “Wellness and engagement are 2 sides of the same coin. We realize wellness programs bring more than just an ROI (return on investment) to the organization but also a QOI (quality of investment). Programs that improve employees’ quality of life create a happier, engaged workforce and thereby improve presenteeism in the workplace.”

To promote wellness program engagement, Bon Secours leads 9 wellness committees; members act as an extension of the wellness team. Team members are asked to share what they learn from each meeting with at least 10 people — what Meghan calls The Power of Ten. “This approach proliferates information throughout the system. We constantly seek ways to leverage committee outreach and maximize their engagement. As champions for these programs, they also act as management’s eyes and ears. They monitor our progress and identify areas for concern as well as share success stories within the system.”

Spirituality Is Important to Wellness

Meghan loves how the Bon Secours faith-based system draws employees together. “They invest in their people through education but also spirituality. We are showing risk reduction as a result of high-level health promotion programming. But at the end of the day, it’s about the people. Not only does Bon Secours give us permission to be the best we can be but also continuously seeks to help us grow. Being able to openly express our spirituality in the workplace allows those who seek this connection to be more fulfilled in all aspects of the pillars of wellness.”